Provider Demographics
NPI:1487879300
Name:SIDDIQUI, TARIQ SIBGHAT (MD)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:SIBGHAT
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S MESA HILLS DR APT 1116
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5477
Mailing Address - Country:US
Mailing Address - Phone:502-533-3854
Mailing Address - Fax:502-533-3854
Practice Address - Street 1:3640 JOE BATTLE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2628
Practice Address - Country:US
Practice Address - Phone:502-533-3854
Practice Address - Fax:855-300-5330
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7349207R00000X, 207RC0000X
HIMD-24188207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2W1357OtherMEDICARE
TX206638301Medicaid